Background: Rheumatoid arthritis (RA) has been associated with an increased stroke risk, but associations by serostatus (seropositive RA (SPRA) vs. seronegative RA (SNRA)) and with subtypes of stroke (ischemic stroke (IS) or hemorrhagic stroke (HS)) are not well established. In addition, it is not well-known whether the use of biologic and targeted synthetic disease modifying anti-rheumatic drugs (b/tsDMARDs) are associated with altered stroke risk. Methods: This nationwide cohort study used the Korean National Health Insurance Service database and included participants who were first diagnosed with RA in 2010-2017 with no previous history of stroke, and who had a health checkup within 2 years before the index date (45,175 RA patients). They were compared ( 1:3 ratio) with non-RA controls matched by age and sex (135,525 non-RA controls). Results: Patients with RA had significantly higher risk of both IS (aHR 1.47, 95% CI 1.36-1.58) and HS (aHR 1.31, 95% CI 1.15-1.50) compared to controls. SPRA patients showed higher risk for both IS (aHR 1.56, 95% CI 1.43-1.69 SPRA vs. aHR 1.23, 1.08-1.41 SNRA) and HS (aHR 1.40, 95% CI 1.21-1.62 SPRA vs. aHR 1.09, 95% CI 0.86-1.38 SNRA). No difference in stroke risk was observed between bDMARDs users and non-users (aHR 1.66 for users, aHR 1.41 for non-users). However, potential differences were noted with tsDMARDs use (aHR 0.81 for users vs. aHR 1.43 for non-users), although not statistically significant. Conclusion: Patients with RA are at significantly greater risk for both IS and HS compared to those without RA and that SPRA patients showed higher risk than SNRA patients. Further studies are required to determine the potential of tsDMARDs in the prevention of stroke in RA.
Shin et al. (Sat,) studied this question.